Acute tonsillitis is a disease of local origin, which is manifested by local inflammation of the lymphadenoid pharyngeal ring. Lacunar tonsillitis is characterized by inflammation of the tonsils, namely lacunae, accompanied by the spread of purulent plaque over the entire surface of the soft palate.

The characteristic features of acute lacunar tonsillitis include the absence of purulent formations outside the source of infection.

The disease is characterized by a more severe course and, if not treated in a timely manner, can lead to serious complications.

Lacunar tonsillitis is characterized by the accumulation of pus in the lacunae of the tonsils and the formation of purulent plaque on their surface

Children of primary preschool and school age from 5 to 12 years are at risk. As for adults and adolescents, their lacunar form most often is not a separate disease, but is combined with other types of acute tonsillitis or a sluggish chronic process.

Causes

The causative agents of the disease are gram-positive and gram-negative pathogenic microflora, pathogenic fungi

The disease occurs as a result of the penetration of pathogenic microflora into the tissues of the tonsils and pharynx, and its main pathogens are bacterial agents such as:

• staphylococci;
• group A beta-hemolytic streptococci;
• pneumococci;
• hemophilus influenzae;
• meningococci;
• pathogens of typhoid fever and anthrax (extremely rare);
• Klebsiella

Among viral pathogens, adenoviruses and enteroviruses can provoke lacunar tonsillitis. You can become infected with the disease either through household or airborne transmission.

There are known cases when the infection entered the human body through other pathological foci: abrasions, wounds, inflamed internal organs, maxillary sinuses, carious teeth, after surgical manipulations and hematogenous routes.

When a disease appears, the state of the human immune system plays a determining role. Most often, the disease occurs in people with a weakened immune system, after an infectious disease, as well as in women during pregnancy (due to suppressed functioning of the immune system).

Systemic diseases can also undermine a person’s immunity, therefore, lacunar tonsillitis often occurs in people with diabetes mellitus, systemic lupus erythematosus, tuberculosis, rheumatism, who have diseases of the blood, nervous system, lungs and cancer.

Risk factors for developing lacunar tonsillitis

The following factors contribute to the development of acute lacunar tonsillitis:

• unfavorable environmental conditions;
• poor nutrition;
• avitaminosis;
• severe hypothermia;
• tonsil injuries;
• stress.

An unhealthy lifestyle and constant stress often cause lacunar tonsillitis.

In adults, the disease can be triggered by constant irritation of the mucous membranes from tobacco smoke, alcohol, in childhood - as a consequence of an untreated inflammatory process.

Signs and main symptoms of the disease

The incubation period for lacunar tonsillitis lasts 1-2 days, and its symptoms develop rapidly and can appear in a couple of hours.

Symptoms that make up the clinical picture of lacunar tonsillitis:

• high temperature 38-39 degrees;
• malaise;
• fever;
• chills;
• general weakness;
• aching muscles and joints;
• headache;
• sleep disturbance;
• inflammation of the mucous membrane;
• Sometimes there is pain in the heart area.

Symptoms of the disease are severe sore throat, deterioration of the patient’s general condition, difficulty swallowing

Difficulty swallowing and enlarged regional lymph nodes are also symptoms of lacunar tonsillitis. On palpation, the lymph nodes are painful, and hyperemia of the skin of the neck may be observed.

During pharyngoscopy, enlargement and inflammation of the tonsils are observed, with the formation of lacunae on their surface filled with white or yellow pus. Ulcers can merge with each other, and there is also a purulent plaque on their entire surface, which is superficial and can be easily removed without damaging the tissue.

The inflammatory process can affect either one or both tonsils. The average duration of the disease is 5-9 days, and full performance is restored in 14-17 days. In children, lacunar tonsillitis has a more severe course, accompanied by convulsions, attacks of suffocation, abdominal pain, nausea, vomiting, diarrhea, and pain in the stomach.

If lacunar tonsillitis has a chronic course, then the symptoms are not so pronounced. It develops without an increase in body temperature, and exacerbations occur only as a result of exposure to provoking factors. Chronic acute lacunar tonsillitis is a consequence of reduced immunity, as well as inattention to one’s health.

Consequences of acute tonsillitis

Sore throat requires mandatory medical supervision, especially if a child suffers from it, since if treated incorrectly and untimely, this disease can cause irreparable harm to health.

If treated incorrectly or untimely, lacunar tonsillitis can cause serious complications.

The spread of the infection that provoked lacunar tonsillitis through the upper respiratory tract is fraught with consequences such as: chronic pharyngitis, tonsillitis, pneumonia, otitis media, labyrinth, inflammation of the meninges (meningitis), thyroid gland, regional lymph nodes.

The presence of a focus of bacterial infection in the human body provokes the entry of pathogenic microflora into the blood and tissues of the body, provoking diseases such as myocarditis, heart disease, hepatitis, pyelonephritis, glomerulonephritis, sepsis, purulent abscess, rheumatism, arthritis.

A sore throat caused by the diphtheria bacillus (diphtheria) can be fatal if treated incorrectly or untimely.

Diagnosis of the disease

If a sore throat is suspected, an otolaryngologist should make a diagnosis. In order to identify lacunar tonsillitis, it is necessary to examine the patient’s oral cavity (perform pharyngoscopy). If, during pharyngoscopy, the otolaryngologist notes inflammation of the tonsils, the formation of purulent plaque, hyperemia of the soft palate, enlargement of regional lymph nodes and accumulation of pus in the lacunae, a diagnosis of lacunar tonsillitis is made.

The inflammatory process that characterizes the disease can be detected by conducting laboratory tests such as a blood test, a throat smear, or a biochemical blood test.

Pharyngoscopy makes it possible to confirm the diagnosis - lacunar tonsillitis

Laboratory blood parameters change as follows: the number of leukocytes increases, lymphocytosis and acceleration of ESR are observed. Bacteriological culture, for which a swab from the throat is sent, makes it possible to determine the pathogenic microflora that provoked the disease, as well as to identify its sensitivity to antibiotics. A modern method for determining lacunar tonsillitis is to conduct an express test, the result of which will be ready in a couple of minutes. Antigenic tests make it possible to determine the DNA of pathogenic microorganisms and immediately prescribe an effective antibiotic.

Lacunar tonsillitis is differentiated from diseases such as infectious mononucleosis, follicular tonsillitis, ARVI, pharyngitis.

Therapy for lacunar tonsillitis

Treatment of sore throat in adults, as a rule, does not require observation in a hospital, but children, especially with severe forms of acute tonsillitis, need medical supervision and are placed in a hospital.

Treatment of the disease must be carried out in accordance with medical prescriptions and not self-medicate. Therapy for acute lacunar tonsillitis includes:

• taking antibacterial drugs (up to 7 days). Depending on the severity of the disease and possible complications, antibiotics of the penicillin, macrolide and cephalosporin groups are prescribed;
• antipyretic drugs based on ibuprofen or paracetamol. They help not only relieve fever, but also reduce inflammation of the mucous membrane and pain in the throat;
• antihistamines. Prescribed mainly to children with severe swelling of the mucous membrane and pharynx;
• herbal preparations for tonsillitis;
• immunostimulating agents that help restore the body's defenses;
• vitamin complexes;
• if the causative agent of sore throat is a virus, then antiviral drugs are used;
• gargling to remove plaque and make swallowing easier;
• drinking plenty of water;
• bed rest.

In no case should you endure the disease on your feet, as the risk of complications such as rheumatism, myocarditis and heart disease increases significantly.

Treatment of the disease in children should be carried out under medical supervision

Local treatment consists of the use of antiseptic drugs that have a disinfecting effect, rinsing and inhalation. To relieve pain, you can prescribe sucking tablets - Lisobakt, Trachisan, Strepsils and others.

Surgery

Surgery is simply necessary when an abscess develops on the back wall of the pharynx, as well as if the disease is chronic.

For chronic tonsillitis, laser or surgical lacunotomy can be performed. During this operation, the tissue that surrounds the lacunae is cut to prevent the accumulation of pus. With long-term and unsuccessful conservative treatment, as well as if pathological changes in the tonsils are observed, tonsillectomy is resorted to - complete removal of the tonsils.

Treatment with traditional methods

For any type of acute tonsillitis, traditional medicine recommends taking foods such as honey, cranberries, raspberries, lemon and other sources of vitamin C. In addition, you can use decoctions of medicinal herbs for gargling: chamomile, linden blossom, sage, St. John's wort and others. Decoctions help relieve inflammation, reduce pain and make swallowing easier.

What is the prevention of lacunar tonsillitis?

Don’t forget to visit your local doctor at least once every six months!

The main prevention of acute tonsillitis is:

• rational nutrition;
• hardening;
• healthy lifestyle;
• observing the rules of personal hygiene.

The risk of getting a sore throat is significantly reduced if you avoid stress, hypothermia, contact with sick people, and also take immunomodulators in the autumn-spring period, when the risk of getting an infectious disease increases.

Another name for lacunar tonsillitis or diphtheria-like tonsillitis. With lacunar tonsillitis, the palatine tonsils are affected. Only these tonsils have special depressions - lacunae (hence the name). One palatine tonsil can have up to 20 lacunae, but usually there are 12-14 of them. Lacunae are normally reservoirs for the accumulation of bacterial or viral pathogens that have entered the body. With the condition that the “gates” of infection are the nose, mouth or ear openings, and the pathogen itself can infect their mucous membranes.

Pathogenic bacteria trapped in the gaps are captured by macrophages, but are not completely destroyed, but are “unpacked.” Those. a pathogenic antigen is represented so that T lymphocytes “understand” how to destroy this particular pathogen. This happens normally.

The pathological condition is caused by:

• excessive accumulation of the pathogen in the lacunae(worse when there are several types of pathogenic bacteria) - the immune system may simply not have time to “study” the “guests” and prepare T-lymphocytes for attack;
• if the immune system is already fighting something else, then typical pathogens of lacunar tonsillitis can trigger the inflammatory process (therefore, tonsillitis often occurs against the background of acute respiratory infections, flu, etc.);
• with chronically weak immunity a certain amount of pathogenic bacteria and viruses always remains in the tonsil lacunae, which tend to periodically accumulate, provoking recurrent exacerbations of sore throat.

Lacunar tonsillitis occurs more often in children, but adults also suffer from this disease. The ratio of cases is approximately 60% and 40%, respectively.

Varieties and atypical forms

Lacunar tonsillitis itself refers to the banal forms of tonsillitis.

Exceptions:

• lacunar tonsillitis becomes mixed if the follicles of the tonsils are involved in the inflammatory process (in addition, follicular tonsillitis occurs);
• Lacunar tonsillitis is considered atypical if it is caused by a viral infection (for example, the herpes virus) or some other pathogen atypical for tonsillitis (measles, syphilis, HIV, diphtheria, etc.).

Causes

The main and main reason is weak immunity. Whether its weakening occurs episodically or is a chronic phenomenon does not matter for the development of lacunar tonsillitis. Or a large number of pathogens entered the body at once. For example, during close and prolonged communication with a person who has a sore throat. Moreover, it is not at all necessary that it be a lacunar form, because The main forms of this disease have the same bacteriological picture.

Immunity is suppressed by a large set of factors:

• recent other infectious diseases;
• drug therapy that has an immunosuppressive effect as a main or side effect (mainly hormonal drugs and immunosuppressants used, for example, for autoimmune diseases);
• chemotherapy and radiation therapy for oncology;
• injuries of any kind (the risk of tonsillitis is especially increased by excessive blood loss and hypothermia);
• structural features of the lymphoid tissue of the tonsils (increased looseness, which creates cavities where pathogenic microflora can settle);
• negative environmental factors (unfavorable environmental conditions);
• unhealthy lifestyle, constant stress, poor nutrition, bad habits.

Impaired immune defense makes the body more vulnerable to pathogens of lacunar and other tonsillitis.

Such pathogens include:

• streptococci (especially group A beta hemolytic streptococcus);
• staphylococci (especially Staphylococcus aureus and hemolytic Staphylococcus);
• hemophilus influenzae;
• pneumococci and meningococci (rather rare);
• opportunistic gram-negative enterobacteria - Klebsiella (also quite rare);
• pathogens of typhoid fever and anthrax (extremely rare).

Lacunar tonsillitis can also be caused by a viral infection:

• adenoviruses,
• enteroviruses,
• herpes viruses (for example, cytomegaloviruses).

Many of the listed pathogens can live in the body in small quantities for years.

Symptoms

It is necessary to clarify that pronounced symptoms may not be observed in some cases: in the chronic course of the disease and in many adults. It is guaranteed that the most complete set of signs will be detected in a child during an acute primary attack of the disease.

The entire main clinical picture appears on the first day of the disease, which demonstrates the transience of its development.

At the initial stage (the first few hours), lacunar tonsillitis can be confused with influenza or an acute respiratory infection:

• a sharp increase in body temperature to febrile (38 degrees) and pyretic (above 39 degrees) values ​​(although the rapidity of the temperature increase immediately gives rise to suspicion of a sore throat);
• the throat begins to sore and ache; upon visual examination, hyperemia of the soft and hard palate, palatine tonsils is noted (small, pinpoint, epithelial hemorrhages are possible);
• headache, weakness, weakness, loss of appetite;
• myalgia and arthralgia, aches in the lumbar region and calf muscles are often observed (a common symptom of the onset of influenza).

Then by the end of the day the following appear:

• high temperature turns into hectic fever, when low-grade or even normal temperature in the morning (after sleep) rises to 39-40 degrees in the evening;
• characteristic skin changes on the face: unhealthy, bright blush on the cheeks and cheekbones with severe pallor of the nose and lips;
• the most important and characteristic sign is that purulent formations are found on the surface of the palatine tonsils, visualized as dirty yellow or white plaques; later the plaques are highly likely to cover the entire surface of the tonsils with a purulent film;
• the sore throat intensifies, which in combination with swelling makes the swallowing process problematic;
• despite the pain syndrome, the voice, as a rule, remains normal, not hoarse or hoarse, unless the person is forced to speak much more quietly (hoarseness is a symptom of laryngitis);
• cervical lymph nodes increase in volume and become painful on palpation;
• against the background of a general headache, specific pain may appear, for example, behind the eyeballs, in the jaw joint, etc.;
• in the sternum and behind the sternum, in the area of ​​the heart, a burning sensation, unpleasant heaviness may occur, the pulse when measured even in a calm state of the patient is increased (tachycardia, reaching up to 100 beats per minute).

Photo of lacunar tonsillitis: what it looks like

The first photo shows a clinical picture in the pharynx characteristic of lacunar tonsillitis.

The second photo shows a comparison of lacunar tonsillitis with other types of tonsillitis based on changes in the pharynx.

Content may be difficult to view

Diagnostics

All diagnostics for this form of angina comes down to three points:

• a throat smear is the main component of diagnosis; it is done not only to determine the causative agent(s) of the disease, but also to exclude other infections, for example, diphtheria, which in its symptoms can be very similar to lacunar tonsillitis (hence the alternative name for this sore throat). Also, sore throat can be confused with the initial phase of scarlet fever or infectious mononucleosis;
• examination of the patient, taking note of his complaints, simple pharyngoscopy;
• blood test - allows you to clarify the diagnosis due to characteristic changes (the number of leukocytes can reach up to 35*109/l, and the erythrocyte sedimentation rate up to 60 mm/h).

The importance of a simple visual inspection should not be underestimated. For example, diphtheria on the tonsils gives a grayish coating, which almost always extends beyond the tonsil zone. With lacunar angina, purulent plaques are easily washed off, but with diphtheria it is noticeably worse. In lacunar angina, the mucous membrane of the tonsils under the purulent layer is not damaged, but in diphtheria, erosions are detected.

Separately, it is worth mentioning the antibiogram, which clarifies not the diagnosis, but the sensitivity of the pathogen to certain antibiotics. When paper mugs impregnated with various antibiotics are placed on the nutrient medium with the isolated pathogen. And based on the degree to which bacteria avoid this or that piece of paper, the required drug is determined.

In diagnosis, it is necessary to determine the nature of the sore throat - bacteriological or viral. Because antibiotics do not work on most viruses. The difference between viral and bacteriological sore throat is clearly determined by a blood test. With viral tonsillitis, leukocytes almost do not increase, band neutrophils do not increase, but the level of lymphocytes is very high. With bacteriological tonsillitis, all of the above points are exactly the opposite.

Treatment of lacunar tonsillitis

Treatment of lacunar tonsillitis is represented by the following points:

• antibacterial (systemic and sometimes local antibiotics);
• anti-inflammatory and antiseptic (rinsing, irrigation, lubrication and inhalation);
• antipyretics and painkillers;
• antiviral drugs (possibly, especially if viral tonsillitis occurs);
• antihistamine action (possibly, especially when a child is sick).

The standard course of treatment is 10 days, but varies depending on the age and condition of the patient. Semi-bed rest is recommended. Lacunar tonsillitis is treated conservatively. In Soviet medicine, lacunar tonsillitis was often considered an indication for tonsillectomy, but later this approach was abandoned. There is much more harm from removing tonsils than benefit. Today this is only used for recurrent abscesses.

Physiotherapeutic treatment

This type of therapy is always considered auxiliary, additional. And it is used after the peak period, when the most severe condition is over.

However, its therapeutic effect is undeniable:

This is the main set of physiotherapeutic techniques. But there are also many additional ones that are not included in official medicine on other grounds. For example, treatment with a Minin reflector, better known as a blue lamp.

Rinsing and irrigation

With lacunar tonsillitis, rinsing with various solutions, decoctions and infusions plays an important role. Not only due to its antiseptic and anti-inflammatory effect, but also because rinsing itself helps remove purulent discharge from the tonsils.

There are a huge number of rinsing products. Here are just a few:

• sea ​​water is perhaps the most famous, very easy to prepare, and at the same time very effective remedy (for 200 ml of boiled lukewarm water, 1 level teaspoon of baking soda, a pinch of salt and 1-2 drops of 5% iodine solution);
• weak solution of potassium permanganate- carefully (this is important) dissolve a few grains of potassium permanganate in 200 ml of boiled lukewarm water, the crystals of the substance must completely dissolve, otherwise there is a considerable risk of getting a chemical burn to the mucous membrane;
• nitrofural tablet (furacilin) dissolve similarly in 200 ml of water;
• garlic infusion- 2 cloves of garlic, pour 200 ml of boiling water and leave for 60 minutes, after which you can gargle with the resulting infusion;
• calendula solution- dilute 1 teaspoon of calendula with alcohol in 200 ml of boiled water, the rinse is ready;
• any herb (chamomile, St. John's wort, sage or a mixture of herbs) brew (instructions are on the package), the resulting “leaf tea” can be additionally diluted with water, or you can use it ready-made - for rinsing or for oral administration.

Rinsing must be done at least 4-5 times a day, and after the procedure, do not eat or drink anything for at least 20 minutes.

Lubricating the mucous membranes of the tonsils

There are otolaryngologists who claim that in case of lacunar tonsillitis, lubrication of the tonsils and removal of purulent films from their surface, on the contrary, are contraindicated. Because this can lead to generalization of the infectious process to the entire throat. There is a lot of reliable clinical evidence for this statement. Probably, in individual cases with powerful attacks of tonsillitis, disruption of the purulent film leads to a sharp release of a large amount of pathogenic microflora into the throat. But this does not unequivocally discredit the method of treatment itself.

To be on the safe side, it is recommended to resort to lubrication already at the stage of decline of the disease. And, of course, after consulting a doctor. Especially when it comes to a child’s sore throat. For lubrication, use a long stick with a cotton or gauze swab at the end (all this can be purchased at the pharmacy).

You can lubricate the surface of the tonsils with rotokan, chlorhexidine, miramistin (it copes very well with fungal infections). Methods of dilution and dosage are indicated in the instructions, but usually we are talking about weak aqueous solutions, which are used to moisten the tampon. If you resort to Lugol's solution, then only at the final stage of treatment, since iodine can burn the already inflamed mucous membrane.

Inhalations

Inhalations do not remove purulent plaques from the tonsils, but can have a noticeable anti-inflammatory, antiseptic and analgesic effect. The peculiarity of inhalation is that here the drug enters the tissues in the form of a finely dispersed medium - an aerosol. Which causes very fast absorption. The choice of inhalations is also quite large: Ingalipt, Cameton, Hexoral, etc. Recently, a device for home inhalation - a nebulizer - has gained great popularity among consumers. A huge plus is that you can load any healing mixture into its working container. And the device will turn the solution into an aerosol.

Pills

Antibiotics for tonsillitis are almost always used systemically, i.e. inside the body. And in fact, in terms of therapeutic effect, there is not much difference between oral administration (swallowing tablets) and intramuscular injections. Simply, oral administration may be difficult due to severe pain in the throat. Or a serious stomach disease (ulcer).

It is immediately worth noting that independent choice of antibiotics is not recommended. Such prescriptions must be made by the attending physician. We must remember that antibiotics also attack beneficial microflora. In certain cases (viral tonsillitis), standard antibiotics will not work.

For lacunar tonsillitis, the following series of antibacterial drugs are used:

1. Ampicillin, Amoxicillin and other penicillin derivatives- successfully destroy a wide range of gram-positive and gram-negative bacteria, including all cocci, diphtheria, hemophilus influenzae, etc., but there is a serious drawback - bacteria can become resistant (often with chronic tonsillitis).
2. Cephalosporin antibiotics, especially representatives of the first and third generations (Cefalexin, Cefadroxil, Cefotaxime, Cefoperazone, Ceftibuten, Cefixime) are considered the second line after the penicillin series, when penicillin derivatives show insufficient antibacterial activity against specific pathogens.
3. Macrolides (Spiramycin, Amoxiclav, Flemoxin, Sumamed) are the third line in antibacterial therapy for lacunar angina, characterized by a low level of toxicity and hypoallergenicity (thus, the risks of cross-allergy with beta-lactams are eliminated).

In addition to antibiotics, “tablet” therapy includes antipyretics and painkillers. As a rule, these are NSAIDs: Analgin, Nurofen, Pentalgin, Ibuprofen, Paracetamol, etc. If there is a viral sore throat, then the main ones are antiviral drugs - Cycloferon, Arbidol, Ingavirin, Fluconazole, Acyclovir, etc.

Finally, antihistamines, antiallergic drugs: Suprastin, Loratadine, Erius (Desloratadine). Antiallergic drugs are needed to prevent possible drug allergies, which are especially common in children. Sore throat is inflammation, allergy is inflammation. One strengthens the other.

Needle aspiration, abscess incision, tonsil removal

For lacunar angina, none of the listed surgical procedures are used or needed. But lacunotomy (surgical or laser) for recurrent forms may be indicated: the tissues near the lacunae are dissected so that with further fusion the depth of the lacunae noticeably decreases. This prevents the accumulation of pus.

Diet

There is no special diet for this disease. Food should be such that the mucous membrane is not subjected to mechanical, thermal or chemical irritation. Plenty of warm drinks are recommended.

Treatment with folk remedies at home

It should be borne in mind that folk remedies are just an addition, and the backbone of treatment includes taking antibiotics and consulting a doctor.

A few “folk recipes”:

• grate fresh beets (1-2 pcs.), squeeze to get at least 150 ml of beet juice (can be diluted a little with warm boiled water), gargle with this juice (at least 3 times a day, week);
• An alcohol or vodka compress helps against swelling of the tonsils (moisten a bandage or gauze, apply it around the neck and wrap a dry bandage on top for an hour or two);
• cover your neck with fresh cabbage leaves and wrap a scarf for a couple of hours;
• Pour 4 fresh plantain leaves into 200 ml of boiling water, leave for an hour, then rinse (every 3 hours until the final phase of recovery);
• any consumption of aloe leaves and juice - in ground form, with tea, with honey, with milk, 30 ml of juice or one ground leaf per day is enough (but aloe is not recommended for allergy sufferers and children under 3 years old);
• 4 g of Rhodiola rosea root pour 500 ml of vodka, keep in a dark place for at least 4 days, 10 ml of the resulting tincture is diluted with 100 ml of boiled water - another folk remedy for rinsing is ready (due to the duration, it is better to prepare such a tincture preventively).

It is difficult to give specific recommendations here. Is it just that lacunar tonsillitis requires the involvement of professional doctors: a pediatrician, an otolaryngologist, a therapist, an infectious disease specialist, and sometimes a rheumatologist. Letting the disease take its course or self-medicating is unacceptable. Taking antibiotics requires maintenance therapy to restore beneficial microflora. Therefore, in parallel, you need to take probiotics and prebiotics (Enterol, Eubicor, Bifiform, Linex, Inulin, etc.). Sore throat is especially dangerous for people under 13 years of age.

Prevention

There is no specific prevention, there is only general:

• good nutrition;
• healthy and sufficient sleep;
• regular moderate physical activity in the fresh air;
• periodic intake of multivitamin complexes;
• avoiding bad habits;
• taking immunostimulants and immunomodulators during stressful and vulnerable periods;
• timely and high-quality treatment of a sore throat.

Complications and consequences

There are two points to note here:

1. Phlegmonous paratonsillitis- a very formidable disease, since it itself can give new, even more formidable complications (occurs against the background of a chronic, recurrent course of lacunar tonsillitis), the consequences can be very sad, including disability and death (for example, if paratonsillitis provoked purulent meningitis or blood poisoning ).
2. Children may experience swelling of the larynx and, as a result, suffocation (this condition is called false croup), here it is necessary to urgently relieve inflammation (often you have to resort to hormonal drips) so that hypoxia does not occur.

Is it contagious and how is it transmitted?

Because Lacunar tonsillitis is of an infectious nature in 99% of all cases (not counting unique autoimmune reactions); naturally, it is contagious. A person becomes contagious during the incubation period (1-2 days before the first symptoms appear) and remains so until complete recovery.

Methods of infection:

• airborne - if you just stay near the patient for enough time;
• through shared utensils;
• through food (therefore you cannot finish eating or drinking anything while sick).

In particular, contact of the patient with children and people already suffering from something (for example, acute respiratory infections) is unacceptable.

Features in children

Apart from the already mentioned false croup and higher sensitivity to pathogens, children do not have any specific features regarding lacunar tonsillitis.

During pregnancy

Apart from the fact that a pregnant woman’s body is already in a state of increased stress and tension, it should be noted that antibacterial therapy is contraindicated in the first trimester of pregnancy. Most antibiotics should not be taken during this period. But in the last 10 years, a number of drugs have appeared that have antibiotic properties, but can be taken at any stage of pregnancy. By the way, macrolides are just one of these.

Video about sore throat

This video talks about the measures and methods of treatment that a person can apply independently as part of pre-medical care. With strong immunity, they can help even without antibiotics.

Forecast

The prognosis for lacunar tonsillitis is favorable. The disease is not considered dangerous to life and health if the treatment is competent and timely and if there are no additional aggravating factors (for example, a sore throat due to another serious infection).

It is called an acute infectious disease that affects the tonsils. The lacunar form of tonsillitis, as a rule, affects the palatine tonsils, namely, the crevices in these organs, which are called lacunae or crypts. The lacunae penetrate the entire tissue of the tonsils; they have many branches, in which pus accumulates during sore throat.

Lacunar tonsillitis is most often caused by pathogenic microorganisms. A high incidence of this disease occurs during the cold season. Along with the decrease in air temperature, the reactivity of the human body weakens. As a result of the lesion, the patient’s condition deteriorates greatly, and dangerous complications may develop.

It is more difficult than in adults, so treating them at home is not recommended. If you have signs similar to purulent inflammation, we recommend going to the hospital immediately. There you will be diagnosed and given adequate treatment.

Causes of the disease

The reason for the development of inflammation in the tonsils is an increase in the pathogenicity of such bacteria:

• beta-hemolytic streptococcus from group A;
• pneumococci;

Other microorganisms can also cause lacunar tonsillitis, but the 3 types listed are the most common.

Factors that provoke the occurrence of sore throat:

• hypothermia;
• viral disease (, etc.);
• abnormalities in the development of the tonsils;
• who have not been treated for a long time;
• lack of vitamins;
• not a healthy diet;
• smoking and frequent consumption of alcohol.

Interesting fact! People who are used to breathing through their mouths are more susceptible to infection by pathogenic microflora.

Is lacunar tonsillitis contagious and how is it transmitted?

Yes, lacunar tonsillitis is very contagious. Patients with this diagnosis should be isolated in infectious diseases departments.

Infection can occur through household means. Therefore, the patient must be provided with separate dishes and care items.

The incubation period for lacunar tonsillitis ranges from 12 hours to 2 days. During this period, the patient does not know about his illness, but can already infect others.

Lacunar tonsillitis: symptoms and clinical manifestations, temperature with lacunar tonsillitis

Symptoms of lacunar tonsillitis include:

• fever. The temperature rises almost immediately to 38-39C. This is a natural response of the immune system to infection in the human body. As the temperature rises, chills and muscle pain are also noted. A temperature within 38.5C is not so dangerous, but when it rises to a critical level, convulsions, delirium or respiratory arrest may begin. In this case, emergency medical care is required. In rare cases, lacunar tonsillitis without fever occurs;
• sore throat. Occurs as a result of swelling of the glands;
• suffocation (consequence of severe swelling);
• the lymph nodes in the neck and jaw become swollen and painful;
• headache.

The tonsils look hyperemic, white-yellow or gray plaques appear on their surface. At first they are located in the lacunae, but then they spread to almost the entire surface of the organ. Plaques are easily removed without damaging the tonsil tissue or bleeding.

Also, a manifestation of lacunar tonsillitis is a complication of a person’s general condition, weakness, loss of appetite, fatigue. Children often feel even worse. They may experience abdominal pain, diarrhea, and vomiting.

Important! With severe tonsillitis, pain appears in the lower back and at the site of the heart, which may indicate cardiac or renal complications.

Diagnosis of lacunar tonsillitis

A therapist or otolaryngologist can diagnose a sore throat. Initially, he collects the patient’s medical history, conducts an external examination, checks the condition of the pharynx and larynx, and palpates the lymph nodes. Also, to diagnose lacunar tonsillitis, a clinical blood test and a general urine test are prescribed. Analysis for lacunar angina usually shows a highly elevated level of leukocytes and accelerated ESR, and protein is present in the urine.

It is good to make smears from the surface of the tonsils for bacteriological examination. This method allows you to identify the pathogen that caused the disease and, based on this data, prescribe an appropriate antibiotic.

Additionally, examination of the nose and ears, immunological examination, and ECG may be required. If surgery is planned, other necessary tests may be prescribed, including x-rays and CT scans.

Treatment of lacunar tonsillitis: antibiotics, sprays, tablets, etc.

When the diagnosis is confirmed, the question arises: should I go to the hospital? This decision depends on the severity of the patient's condition. If the patient's general condition is not severely impaired, the doctor may decide to treat him at home. The patient is given the necessary prescriptions and only then released. If it occurs in a severe form or is diagnosed in a child, treatment at home is out of the question.

For purulent tonsillitis, bed rest, plenty of fluids and diet are very important. The most important component of the treatment of lacunar tonsillitis is antibiotics, which are necessary to eliminate the cause of inflammation, that is, bacteria.

The following drugs are most often used:

• "Suprax"
• "Cephalexin"
• "Azithromycin"
• "Ceftriaxone".

In the hospital they are usually given intramuscularly or intravenously.

Can be taken at home, but only as prescribed by your doctor. The course, as a rule, lasts 5-10 days and must be completed to the end. If you see that one antibiotic does not help, then it should be changed. For this, bacteriological analysis data may be required.

The temperature in lacunar sore throat can be brought down with any antipyretic drug ("", "Rapidol", "", "Antigrippin", "Arofen for children"), but be prepared for the fact that it will last a couple of days until the antibiotics begin to act.

Interesting to know! The duration of the disease with proper treatment is 5-10 days, but in children and in severe cases this period can increase to 2 weeks.

In addition to antibiotic therapy, the following drugs are used to eliminate the symptoms of lacunar tonsillitis:

• antihistamines ("", "Dexamethasone", "Diazolin") to reduce swelling of the tonsils;
• anti-inflammatory drugs to eliminate inflammation and relieve symptoms in the throat. They may be prescribed in the form of tablets or throat sprays. Sprays ("", "Kameton", "Givalex", "Sore throat with calendula") are suitable for lacunar sore throat in adults and children at least 3 years old;
• antiseptics for the throat, which help destroy bacteria locally and cleanse the oral cavity of pus and germs. Some antiseptics can be used to gargle (solutions such as Miramistin, Orasept, Furacilin, Chlorophyllipt, alcohol tinctures of calendula or propolis are suitable for this), while others can be used to lubricate the tonsils (Lugol's or iodine). Among the most popular is soda-salt solution. It is accessible to everyone and has good cleansing properties. Chamomile decoction is also widely used. They gargle with it for sore throats and also drink it instead of tea. Please note that procedures need to be carried out as often as possible, preferably once every 1-2 hours;
• lozenges with an analgesic and antimicrobial effect (“Strepsils”, “Faringosept”, “Neo-angin”, “Rinza Lorsept Plus”, “Trachisan”, “Decatylene”). They are used in addition to the listed medications.

Since bacterial lacunar tonsillitis undermines the immune system, the following immunomodulatory drugs can be prescribed to increase it: “”, “Interferon”, “Ingavirin”, “Imudon”, “Immunal”.

Protracted purulent lacunar tonsillitis is treated by washing the lacunae of the tonsils. This procedure helps to wash out purulent plugs, disinfect lacunae and speed up recovery. Rinsing is carried out using a special syringe with a blunt needle, but the vacuum method is considered more effective, when the contents of the lacunae are sucked out using a vacuum suction. The number of procedures required for cure can be up to 10 times.

Extreme measures for lacunar tonsillitis involve surgical opening or removal of the tonsils. Lacunotomy is designed to remove purulent contents from the tonsils, along with the affected areas, while preserving the organ. This operation can be performed using a conventional scalpel or laser. Laser lacunotomy is safer and less traumatic.

Tonsillectomy is performed when there is a real threat of complications, as well as with constant relapses of the disease. After such an operation, a further course of rehabilitation is necessary.

Antibiotics for lacunar angina help avoid these complications, so do not delay taking them.

Prevention of lacunar tonsillitis

To prevent lacunar tonsillitis, you need to take care of your immunity. Strengthen it with healthy eating, exercise and exercise, and eliminate bad habits from your life.

Also remember that in cold weather it is important to dress warmly. This is especially true for children. To reduce the risk of a viral disease, which can subsequently trigger a sore throat, during an epidemic, avoid visiting crowded places or wear a protective mask, as viruses are transmitted by airborne droplets.

Informative video

In humans, the palatine tonsils serve as a protective organ and are located in the oropharynx. Their surface has many depressions or lacunae that go deep into the tissue; the area of ​​the ducts can only be compared with the wall of the oropharynx, it is approximately 350 square centimeters. It is not for nothing that the area of ​​the tonsils is so large; this is necessary so that there is greater contact between the lymphoid tissue and microorganisms. When this tissue becomes inflamed, lacunar tonsillitis develops, which will be discussed further.

Acute lacunar tonsillitis is a purulent inflammation of the cavity of the lacunae of the palatine tonsils. It occurs at all ages, but is especially common in childhood and adolescence. In an adult, a chronic infection of the oral cavity usually worsens and is diagnosed before the age of 50. At older ages, the risk of the disease decreases. The risk of getting sick remains all year round, however, the peak occurs from October to January.

Causes

The development of sore throat does not happen just like that; there are certain reasons for this, which can be primary or secondary. The primary ones include:

• streptococci;
• staphylococci;
• fungi;
• viruses.

The secondary variant develops when surrounding tissues are damaged. It occurs when:

• scarlet fever;
• tuberculosis lesion.

There are also several routes through which infection occurs. There are three in total:

• airborne;
• with food;
• domestic.

Among the reasons, it is worth noting factors that predispose to the development of pathology. These factors are:

Symptoms

Before treating lacunar tonsillitis, it is necessary to determine the symptoms that may manifest the disease. Symptoms develop very quickly and are accompanied by an increase in temperature from 38 to 39 and even 41 degrees. Daily temperature fluctuations within 2-5 degrees are possible.

Intoxication increases sharply and rapidly, this condition is manifested by weakness, headache, fatigue, loss of appetite, and disturbed sleep. Tonsillitis manifests itself as pain in the throat, especially during swallowing, and joints and muscles ache and ache.

Sore throat also manifests itself as reddening of the cheeks, while the nose and upper lip remain pale. But the mucous membranes give very vivid symptoms; they acquire a bright red color, especially in the area of ​​the tonsils, palatine arches and soft palate. In the gaps on the mucous membrane of the tonsils, there is an accumulation of pus, which is called plugs. Symptoms are complemented by enlarged lymph nodes in the neck and under the lower jaw. The heart begins to beat faster, which is called tachycardia and is 90 beats per minute or more.

Special diagnostics

In addition to the information provided by the symptoms, the diagnosis must be confirmed by special studies conducted by the attending physician. It is indicated to culture the flora and its sensitivity to antibacterial drugs. A smear is also made, which is examined under a microscope. If the viral nature of the disease is suspected, a polymerase chain reaction is indicated, which will help identify the pathogen if it is a virus. Among them may be:

• adenoviruses;
• herpes virus;
• cytomegalovirus.

It’s not enough for a person to simply find out the symptoms that manifest the disease. Additionally, the doctor is interested in information about how it started and after what, how it proceeded. The period from the moment the first symptoms appear and what the person is associated with its development.

Treatment of the disease

Regardless of the severity of the symptoms, the person is indicated to be hospitalized in a hospital. In order to successfully cure the pathology, bed rest is indicated, as well as a maximum limitation of the number of contacts with a patient with tonsillitis. During this period, food should be warm, pureed and not spicy, but you need to drink as much liquid as possible.

The methods used to treat lacunar tonsillitis in adults are the same for other variants of the disease. Everyone starts with conservative treatment, and if the tonsils become larger and interfere with normal breathing, then surgery to remove them is indicated.

Antibacterial agents

This group of drugs is used if there is a microbial cause of the disease. At the initial stage, the use of broad-spectrum drugs is indicated; sulfonamides are used less frequently. With the help of antibacterial drugs, microorganisms are destroyed, but provided that they are bacteria. This group of drugs has no effect on viruses. If everything is chosen correctly, then complete destruction of the pathogen is achieved with minimal side effects.

Commonly used drugs are:

• cephalosporin series;
• macrolides;
• fluoroquinolones.

To reduce temperature

This group of drugs is indicated when the temperature rises above 38 degrees. It is believed that if the temperature is lower, the body is able to resist infection on its own. A group of non-steroidal anti-inflammatory drugs are used as antipyretics. They reduce inflammation, sore throat, and headache, which is typical for sore throat.

It is unacceptable to prescribe drugs from this group on your own, since side effects may occur in combination with penicillins. There is also a risk of developing or exacerbating peptic ulcers if taken uncontrolled.

In childhood, such drugs are used in the form of a syrup or suspension with a pleasant taste. The duration of the reduction in temperature is from 3 to 4 days, after which the condition should gradually return to normal.

Antihistamines

For lacunar forms of tonsillitis, this group of drugs is also indicated. It is worth noting that in combination with macrolides they can have a toxic effect on the heart. The drugs help reduce swelling of the tonsils and pharynx, reduce the risk of laryngeal spasm, and breathing improves after taking them. This group is also indicated for the treatment of sore throat in childhood, as well as for people who are prone to various types of allergic reactions.

Local treatment of the disease

To achieve the maximum positive effect, topical medications are used for angina. With the help of rinses, the mucous membrane of the pharynx is disinfected, the symptoms of the disease are reduced and, most importantly, the purulent plugs that clog the lacunae of the tonsils are washed out.

As a local treatment option for sore throat, absorbable tablets and irrigation products are used. The doctor can also prescribe lozenges and lozenges, which will disinfect the throat, and the medicinal components will go directly to the site of inflammation. There are several remedies that can be successfully used as local treatment:

1. Rinse using solutions of furatsilin, as prescribed by a doctor, boric acid. A solution of soda, hydrogen peroxide, and pale pink potassium permanganate is an excellent solution for removing congestion in case of sore throat.
2. Rinses can be prepared using salt or soda and water, with the addition of iodine.
3. Medicinal herbs, for example, chamomile and sage, are excellent in reducing inflammation in sore throat.
4. Irrigation of the tonsils with sea water, which can be freely found at the pharmacy, has a beneficial effect on the mucous membrane of the tonsils.
5. Special preparations are also used for irrigation purposes; they are selected at the discretion of the doctor.

Folk recipes

On the positive side, traditional medicine has proven itself in many ways, but it is recommended to use them only after consultation with the attending physician, and also as a supplement to the prescribed treatment for angina. There are several recipes that will help speed up the healing process.

To begin with, you can try melting a tablespoon of butter and adding the same amount of honey, a pinch of baking soda and, stirring, until everything acquires a homogeneous consistency. The product is used warm; it must be dissolved in a teaspoon three times a day in the mouth.

For the second recipe, you will need a glass of preheated water, in which a spoonful of honey and a teaspoon of apple cider vinegar are dissolved. Gargle the throat with the solution four times during the day.

Add a teaspoon of apple cider vinegar to a glass of freshly squeezed beet juice. The product is heated, and then the oropharynx is rinsed with it for a minute. The procedure is repeated four times during the day.

The healing properties of propolis have been known for a long time; it has proven itself on the positive side for sore throats. For a sore throat, a piece of it must be chewed for five minutes three times a day.

It is useful to gargle with a propolis-based tincture, having previously dissolved it with water.

Alkaline mineral water is poured into the nebulizer, after which inhalation is carried out for 10 minutes. The entire procedure is repeated three times a day in order to soften the mucous membrane of the throat and tonsils, and the pain gradually goes away.

Add a spoonful of grated ginger to a glass of brewed black tea; only the root of this plant has healing properties. Then put a slice of lemon into the glass. After 20 minutes, you need to drink warm tea; it is recommended to keep the liquid in the mouth for a while in order to quickly get rid of a sore throat.

Surgery for sore throat

In the event that frequent relapses of lacunar or other forms of angina occur, surgical intervention is indicated. It can be performed in several ways, the simplest of which is to clean lacunae and leaks from purulent contents. Diathermocoagulation and galvanocaustics of lacunae are used for this purpose.

In recent years, laser opening of lacunae and cold treatment has gained wide popularity. After the procedure, the changed areas are frozen, resulting in the prevention of exacerbation. If all the above methods do not bring results, then the altered tonsils are removed, the operation is called tonsillectomy.

Diagnosis of angina, as well as the method of treatment, is carried out only by a doctor, otherwise there is a risk of complications, including death. When you first suspect a disease, it is better to seek help from a specialist, and then be completely cured. Prevention of relapse is of no small importance.

- an acute inflammatory process of predominantly bacterial etiology, which is characterized by damage to the lacunae of the tonsils and is manifested by a pronounced disturbance in the general condition, pain in the throat, which intensifies when swallowing. On physical examination, the tonsils are enlarged, hyperemic, and purulent exudate is visible at the mouth of the lacunae. When palpating the regional lymph nodes, pain is noted. To identify the pathogen, a bacteriological analysis of a throat smear is performed. Treatment involves maintaining bed rest during the acute period, prescribing antibiotics, anti-inflammatory drugs, gargling with antiseptics, and physical therapy.

General information

Causes of lacunar tonsillitis

This is an acute infectious disease, the main pathogens of which in children under 5 years of age are adenoviruses, Coxsackie viruses, measles and scarlet fever, in adolescents and adults (in 80% of cases) - streptococci, staphylococci, Haemophilus influenzae and other bacterial agents. Pathogens penetrate the upper respiratory tract with inhaled air, less often through contact and household contact and are localized on the tonsils. With a decrease in immune defense, pathogenic microorganisms are activated, accumulate in the lacunae and develop a pathological process in the lymphoid formations of the pharyngeal ring. It is possible for streptococci and other bacteria to spread through the bloodstream to other organs and tissues (heart, kidneys, joints), which, against the background of a decrease in the body’s defenses and inadequate antibiotic therapy, leads to various complications: myocarditis, endocarditis, polyarthritis, glomerulonephritis.

Symptoms of lacunar tonsillitis

Clinical symptoms are characterized by a combination of local changes in the pharynx and lymphoid tissues with a disturbance in general well-being. The disease begins acutely with the appearance of symptoms of intoxication: hyperthermia with chills, body aches, and headache. On days 2-3, a sore throat occurs, which becomes more intense when swallowing food and saliva. Due to the enlargement of the maxillary and cervical lymph nodes, there is pain when opening the mouth and turning the head. There is an unpleasant odor from the mouth, and speech is slurred (“nasal tone”). Examining the oral cavity, you can notice redness and swelling of the tonsils, yellowish-white contents in the form of separate islands, which quickly connect, covering the surface with purulent films.

Sore throat in children is accompanied by more severe intoxication, which is manifested by fever, severe headaches, repeated vomiting, syncope with loss of consciousness, decreased appetite, restless sleep, weakness, and irritability. Often there are signs of disruption of the digestive tract with abdominal pain, nausea, and diarrhea. Complaints of discomfort in the throat when swallowing food and water may be absent in the first 1-3 days.

Complications

Purulent inflammation with inadequate treatment and decreased immunity can cause a paratonsillar or retropharyngeal abscess, and also spread to the paranasal sinuses and middle ear. In this case, hyperthermia persists, the pain in the throat becomes pulsating and can radiate to the ear, opening the mouth becomes difficult, as does eating. Repeated sore throats lead to the development of chronic inflammation in the lymphoid tissue of the pharynx and surrounding tissues - chronic tonsillitis, as well as damage to distant organs and tissues: heart muscle, kidneys, joints.

Diagnostics

To correctly interpret the clinical symptoms observed with lacunar angina and to distinguish primary from secondary inflammation, a thorough examination by doctors of various specialties is necessary: ​​pediatrician, internist, otolaryngologist, infectious disease specialist, rheumatologist and nephrologist. Examination of the pharynx reveals signs characteristic of lacunar tonsillitis: pronounced infiltration and swelling of the tonsils, accumulation in the lacunae of yellowish islands of purulent contents and films covering the surface of the tonsil. When removing the films with a spatula, they come off relatively easily without damaging the underlying tissue or causing bleeding.

To identify the pathogen, it is necessary to examine the contents of a smear from the throat and tonsils by performing a bacteriological or virological analysis. General clinical tests of blood and urine are prescribed, with the help of which the activity of the process is determined (leukocytosis and increased erythrocyte sedimentation rate in a blood test) and the presence of complications from the urinary system (leukocytes, red blood cells, protein in a general urine test for nephritis). It is necessary to exclude complications (in particular, rheumatism) when performing a biochemical blood test (changes in the level of C-reactive protein, antistreptolysin-O, rheumatoid factor). Differential diagnosis of lacunar tonsillitis is carried out with other diseases of the ENT organs, secondary processes of an infectious nature (diphtheria of the pharynx, scarlet fever, mononucleosis, etc.).

Treatment of lacunar tonsillitis

During the acute period of the disease, it is necessary to observe bed rest; in severe cases and the presence of complications, hospitalization is required.

• Etiotropic therapy. The basis of therapeutic measures for bacterial etiology is antibacterial therapy for 8-15 days in sufficient dosage, taking into account the sensitivity of the pathogen. Antibiotics from the penicillin group (benzylpenicillin, amoxicillin), as well as cephalosporins and macrolides are usually used. For secondary sore throats of viral and fungal etiology, appropriate medications are used (acyclovir, fluconazole, etc.).
• Symptomatic remedies. Nonsteroidal anti-inflammatory drugs (aspirin, ibuprofen, diclofenac), vitamins, immunomodulators, as well as medications that normalize impaired functions of the cardiovascular system, digestive tract, urinary tract, and nervous system are prescribed.
• Local treatment. Antiseptic solutions and decoctions of medicinal herbs are used locally. After the acute manifestations subside, the patient is given a referral for physical treatment.

With the development of local complications (peritonsillar abscess), surgical intervention with opening of the purulent focus is necessary. Treatment for rheumatic carditis and glomerulonephritis is carried out in a specialized hospital using antibacterial agents, glucocorticosteroids and other drugs.

Prognosis and prevention

The average duration of treatment is 8-15 days. This is enough for complete recovery, provided adequate timely therapy. The addition of early and late complications worsens the prognosis and can lead to long-term disability. The main preventive measures are limiting contact with people with colds and sore throats, using personal protective equipment, ventilating the premises, proper work and rest schedule, hardening the body, and regular exercise and sports.